Provider Demographics
NPI:1427226042
Name:LEWIS, MAGDALINA (LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALINA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 RED BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2435
Mailing Address - Country:US
Mailing Address - Phone:704-957-0566
Mailing Address - Fax:
Practice Address - Street 1:2432 RED BIRCH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2435
Practice Address - Country:US
Practice Address - Phone:704-957-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008975890OtherBCBSM
MI8008975890OtherBCBSM